Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

2-[ 18 F]Fluoro-2-deoxyglucose positron emission tomography (FDG-PET) assesses a fundamental property of neoplasia, the Warburg effect. This molecular imaging technique offers a complementary approach to anatomic imaging that is more sensitive and specific in certain cancers. FDG-PET has been widely...

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Bibliographic Details
Published in:Clinical cancer research 2005-04, Vol.11 (8), p.2785-2808
Main Authors: KELLOFF, Gary J, HOFFMAN, John M, SHANKAR, Lalitha, LARSON, Steven M, SIGMAN, Caroline C, SCHILSKY, Richard L, SULLIVAN, Daniel C, JOHNSON, Bruce, SCHER, Howard I, SIEGEL, Barry A, CHENG, Edward Y, CHESON, Bruce D, O'SHAUGHNESSY, Joyce, GUYTON, Kathryn Z, MANKOFF, David A
Format: Article
Language:English
Subjects:
Antineoplastic agents
Biological and medical sciences
drug development
FDG-PET
Fluorodeoxyglucose F18
Medical sciences
molecular imaging
Neoplasm Staging
Neoplasms - diagnosis
Neoplasms - diagnostic imaging
Neoplasms - drug therapy
oncology
Pharmacology. Drug treatments
Positron-Emission Tomography - methods
Reproducibility of Results
Sensitivity and Specificity
Survival Analysis
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Summary:2-[ 18 F]Fluoro-2-deoxyglucose positron emission tomography (FDG-PET) assesses a fundamental property of neoplasia, the Warburg effect. This molecular imaging technique offers a complementary approach to anatomic imaging that is more sensitive and specific in certain cancers. FDG-PET has been widely applied in oncology primarily as a staging and restaging tool that can guide patient care. However, because it accurately detects recurrent or residual disease, FDG-PET also has significant potential for assessing therapy response. In this regard, it can improve patient management by identifying responders early, before tumor size is reduced; nonresponders could discontinue futile therapy. Moreover, a reduction in the FDG-PET signal within days or weeks of initiating therapy (e.g., in lymphoma, non–small cell lung, and esophageal cancer) significantly correlates with prolonged survival and other clinical end points now used in drug approvals. These findings suggest that FDG-PET could facilitate drug development as an early surrogate of clinical benefit. This article reviews the scientific basis of FDG-PET and its development and application as a valuable oncology imaging tool. Its potential to facilitate drug development in seven oncologic settings (lung, lymphoma, breast, prostate, sarcoma, colorectal, and ovary) is addressed. Recommendations include initial validation against approved therapies, retrospective analyses to define the magnitude of change indicative of response, further prospective validation as a surrogate of clinical benefit, and application as a phase II/III trial end point to accelerate evaluation and approval of novel regimens and therapies.
ISSN:1078-0432
1557-3265
DOI:10.1158/1078-0432.CCR-04-2626